scholarly journals Under-5 Mortality and Its Associated Factors in Northern Nigeria: Evidence from 22,455 Singleton Live Births (2013–2018)

2021 ◽  
Vol 18 (18) ◽  
pp. 9899
Author(s):  
Osita K. Ezeh ◽  
Felix A. Ogbo ◽  
Anastasia O. Odumegwu ◽  
Gladys H. Oforkansi ◽  
Uchechukwu D. Abada ◽  
...  
Keyword(s):  
Mixed Models ◽  
Caesarean Delivery ◽  
Contraceptive Use ◽  
Low Socioeconomic ◽  
Live Births ◽  
Adequate Care ◽  
Child Spacing ◽  
Adjusted Model ◽  
Size At Birth ◽  
Significant Factors

The northern geopolitical zones (NGZs) continue to report the highest under-5 mortality rates (U5MRs) among Nigeria’s six geopolitical zones. This study was designed to identify factors related to under-5 mortality (U5M) in the NGZs. The NGZ populations extracted from the 2018 Nigeria Demographic and Health Survey were explored to assess the factors associated with U5M using logistic regression, generalised linear latent, and mixed models. Between 2013 and 2018, the northwest geopolitical zone reported the highest U5MR (179 deaths per 1000 live births; 95% confidence interval [CI]: 163–194). The adjusted model showed that geopolitical zone, poor household, paternal occupation, perceived children’s body size at birth, caesarean delivery, and mothers and fathers’ education were highly associated with increased odds of U5M. Other significant factors that influenced U5M included children of fourth or higher birth order with shorter interval ≤ 2 years (adjusted odds ratio [aOR] = 1.68; CI: 1.42–1.90) and mothers who did not use contraceptives (aOR = 1.41, CI: 1.13–1.70). Interventions are needed and should primarily spotlight children residing in low-socioeconomic households. Educating mothers on the benefits of contraceptive use, child spacing, timely and safe caesarean delivery and adequate care for small-sized babies may also reduce U5M in Nigeria, particularly in the NGZs.

scholarly journals Temporal trends in severe maternal and neonatal trauma during childbirth: a population-based observational study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020578 ◽  
Author(s):  
Qi Wen ◽  
Giulia M Muraca ◽  
Joseph Ting ◽  
Sarah Coad ◽  
Kenneth I Lim ◽  
...  
Keyword(s):  
Observational Study ◽  
Vaginal Delivery ◽  
Caesarean Delivery ◽  
Temporal Trends ◽  
Birth Trauma ◽  
Forceps Delivery ◽  
Fourth Degree ◽  
Spontaneous Vaginal Delivery ◽  
Live Births ◽  
Obstetric Trauma

ObjectiveInstrumental vaginal delivery is associated with birth trauma to infant and obstetric trauma to mother. As caesarean delivery rates increased during the past decades, the rate of instrumental vaginal delivery declined. We examined concomitant temporal changes in the rates of severe birth trauma and maternal obstetric trauma.DesignA retrospective observational study.Settings and participantsAll hospital singleton live births in Washington State, USA, 2004–2013, excluding breech delivery. Severe birth trauma (brain, nerve injury, fractures and other severe birth trauma) and obstetric trauma (third/fourth degree perineal lacerations, cervical/high vaginal lacerations) were identified from hospitalisation data. Pregnancy and delivery characteristics were obtained from birth certificates. Temporal trends were assessed by the Cochran-Armitage test. Logistic regression was used to obtain adjusted ORs (AORs) and 95% CI.ResultsOverall, 732 818 live births were included. The rate of severe birth trauma declined from 5.3 in 2004 to 4.5 per 1000 live births in 2013 (P<0.001). The decline was observed only in spontaneous vaginal delivery, the rates of fractures and other severe birth trauma declined by 5% and 4% per year, respectively (AOR: 0.95, 95% CI 0.94 to 0.97 and AOR: 0.96, 95% CI 0.93 to 0.99; respectively). The rate of third/fourth degree lacerations declined in spontaneous vaginal delivery from 3.5% to 2.3% (AOR: 0.95; 95% CI 0.94 to 0.95) and in vacuum delivery from 17.3% to 14.5% (AOR: 0.97, 95% CI 0.96 to 0.98). Among women with forceps delivery, these rates declined from 29.8% to 23.4% (AOR: 0.98, 95% CI 0.96 to 1.00).ConclusionWhile the rates of fractures and other birth trauma declined among infants delivered by spontaneous vaginal delivery, the rate of birth trauma remained unchanged in instrumental vaginal delivery and caesarean delivery. Among mothers, the rates of severe perineal lacerations declined, except for women with forceps delivery.

scholarly journals Immune checkpoint inhibitor use, multimorbidity and healthcare expenditures among older adults with late-stage melanoma

Immunotherapy ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 103-112
Author(s):  
Pragya Rai ◽  
Chan Shen ◽  
Joanna Kolodney ◽  
Kimberly M Kelly ◽  
Virginia G Scott ◽  
...  
Keyword(s):  
Immune Checkpoint ◽  
Late Stage ◽  
Mixed Models ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Checkpoint Inhibitors ◽  
Excess Cost ◽  
Healthcare Expenditures ◽  
Adjusted Model ◽  
The Impact

Background: The objective of this study is to assess the impact of immune checkpoint inhibitors (ICIs) and multimorbidity on healthcare expenditures among older patients with late-stage melanoma. Materials & methods: A retrospective longitudinal cohort study using Surveillance, Epidemiology and End Results linked with Medicare claims was conducted. Generalized linear mixed models were used to analyze adjusted relationships of ICI, multimorbidity and ICI–multimorbidity interaction on average healthcare expenditures. Results: Patients who received ICI and those who had multimorbidity had significantly higher average total healthcare expenditures compared with ICI nonusers and no multimorbidity. In the fully adjusted model using ICI–multimorbidity interaction, no excess cost was added by multimorbidity. Conclusion: Use of ICIs, regardless of multimorbidity, is associated with increased healthcare expenditures.

scholarly journals A rise in births following contraceptive failure in France between 2010 and 2016: results from the French national perinatal surveys

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Camille Bonnet ◽  
Béatrice Blondel ◽  
Caroline Moreau
Keyword(s):  
Contraceptive Method ◽  
Contraceptive Use ◽  
Significant Proportion ◽  
Adult Women ◽  
Contraceptive Methods ◽  
Subsequent Increase ◽  
Contraceptive Failure ◽  
Live Births ◽  
Socially Disadvantaged ◽  
Method Mix

Abstract Background In France, while the prevalence of contraception is high, a significant proportion of pregnancies are unintended. Following the 2012 pill scare, the contraceptive method mix, which was mostly comprised of pills and intrauterine devices (IUD), has become more diversified. In this changing landscape, our objective was to describe trends in live births resulting from contraceptive failure and evaluate how patterns of contraceptive use have contributed to observed changes between 2010 and 2016. Methods We used data from the 2010 and the 2016 French National Perinatal surveys which included all births from all maternity units in France over a one-week period. Interviews collecting information about pre-conception contraceptive practices were conducted in the maternity ward post-delivery. Women were classified as having a contraceptive failure if they discontinued contraception because they were pregnant. Our study sample included adult women who had a live birth, had ever used contraception and did not undergo infertility treatment (n = 11,590 in 2010 and n = 9703 in 2016). We evaluated changes in contraceptive failure over time using multivariate Poisson regressions to adjust for sociodemographic characteristics and pre-pregnancy contraceptive methods. Results Pre-pregnancy contraception evolved between 2010 and 2016 with a 12.3% point-drop in pill use, and conversely, 4.6%- and 3.2%-point increases in IUD and condom use, respectively. Use of other barrier or natural methods doubled between 2010 and 2016 but remained marginal (1.4% in 2010 vs 3.6% in 2016). Between 2010 and 2016, the proportion of live births resulting from contraceptive failure rose from 7.8 to 10.0%, with higher risks among younger, parous and socially disadvantaged mothers. The risk ratio of contraceptive failure in 2016 compared to 2010 remained higher after sociodemographic adjustments (aRR = 1.34; 95% CI; 1.23–1.47) and after adjusting for pre-pregnancy contraceptive method mix (aRR = 1.35; 95% CI; 1.25–1.49). Increases in contraceptive failures were concentrated among pill and condom users. Conclusions Recent shifts in contraceptive behaviors in France following the 2012 pill scare may be associated with a subsequent increase in births resulting from short acting contraceptives failures.

scholarly journals Predictors of Underweight among Children Under-five in Ethiopia

2021 ◽  
Author(s):  
Gebremedhin Desta ◽  
Natnael Mamuye ◽  
Martin Sagayam Kulandairaj ◽  
Denekew Bitew ◽  
Bezarede Mekonnen ◽  
...  
Keyword(s):  
Birth Order ◽  
Educational Level ◽  
Employment Status ◽  
Descriptive Statistics ◽  
Personal Hygiene ◽  
Age Group ◽  
Under Five ◽  
Proximate Factors ◽  
Size At Birth ◽  
Significant Factors

Abstract 9013 under-five children were included for study. Descriptive Statistics and POM were employed identify socio-economic, demographic, and proximate factors of underweight to children among regions of Ethiopia. SAS version 9.4 was used. About 25.3% of children in Ethiopia were underweighted. POM showed that sex, residence, size at birth, age group, incidence of diarrhea, educational level, breastfeeding status, mothers’ employment status, and birth order were found to be significant factors of underweight. Improvement of education for caring child in appropriate age needed. Personal hygiene be improved to prevent exposures to diarrhea and environmental sanitation.

scholarly journals The Impact of Education and Residence on Current Use of Contraception in Ethiopian Women

2019 ◽  
Vol 11 (9) ◽  
pp. 182
Author(s):  
Arif Ahmed ◽  
Mohammad S. Zahangir
Keyword(s):  
Infant Mortality ◽  
Contraceptive Use ◽  
Wealth Index ◽  
Contraceptive Methods ◽  
Logistic Regression Models ◽  
Working Region ◽  
Children Ever Born ◽  
Living Children ◽  
Adjusted Model ◽  
The Impact

BACKGROUND: Maternal and infant mortality is high in Ethiopia. An underlying cause of maternal and infant mortality is unintended pregnancy, which is inversely associated with contraceptive use. Hence, the use of contraception can necessarily be increased to reduce the mortality rate of mother and infant. OBJECTIVES: This study aims to examine the effect of educational attainment and place of residence on contraceptive use among Ethiopian women of childbearing ages. METHODS: Data are obtained from the 2016 Ethiopian Demographic and Health Survey (EDHS) and total 10 223 women aged 15&ndash;49 years are analyzed in this study. Both unadjusted and adjusted multivariate logistic regression models are employed to examine the effect of exposure variables on contraceptive use. RESULTS: It can be seen that only around 36% of Ethiopian women used any of the contraceptive methods. In the case of contraceptive use, a significantly higher odds is observed for women with secondary or higher education with respect to those who were illiterate (e.g., OR=1.51, 95% CI: 1.19&ndash;1.93 after adjusting for total children ever born, number of living children, desire of more children, wealth index, respondent currently working, region and religion; and OR=2.53, 95% CI: 2.05&ndash;3.13 for unadjusted model). Urban women had also a significantly higher odds for contraceptive use than their rural counterparts (OR=1.89, 95% CI: 1.42&ndash;2.51 by adjusted model for the above confounders, and OR=2.22, 95% CI: 1.81&ndash;2.73 by unadjusted model). CONCLUSION: The findings reveal that both educational improvement and urbanization may increase the use of contraception among women in Ethiopia.

scholarly journals Incidence of neonatal mortality and its predictors among live births in Ethiopia: Gompertz gamma shared frailty model

2020 ◽  
Vol 46 (1) ◽  
Author(s):  
Zemenu Tadesse Tessema ◽  
Getayeneh Antehunegn Tesema
Keyword(s):  
Public Health ◽  
Antenatal Care ◽  
Neonatal Mortality ◽  
Frailty Model ◽  
Live Births ◽  
Large Size ◽  
Shared Frailty Model ◽  
Shared Frailty ◽  
Male Sex ◽  
Size At Birth

Abstract Background Neonatal mortality remains a serious public health concern in developing countries including Ethiopia. Ethiopia is one of the countries with the highest neonatal mortality in Africa. However, there is limited evidence on the incidence and predictors of neonatal mortality at the national level. Therefore, this study aimed to investigate the incidence of neonatal mortality and its predictors among live births in Ethiopia. Investigating the incidence and predictors of neonatal mortality is essential to design targeted public health interventions to reduce neonatal mortality. Methods A secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 11,022 live births was included in the analysis. The shared frailty model was applied since the EDHS data has hierarchical nature, and neonates are nested within-cluster, and this could violate the independent and equal variance assumption. For checking the proportional hazard assumption, Schoenfeld residual test was applied. Akakie Information Criteria (AIC), Cox-Snell residual test, and deviance were used for checking model adequacy and for model comparison. Gompertz gamma shared frailty model was the best-fitted model for this data since it had the lowest deviance, AIC value, and the Cox-Snell residual graph closet to the bisector. Variables with a p-value of less than 0.2 were considered for the multivariable Gompertz gamma shared frailty model. In the multivariable Gompertez gamma shared frailty model, the Adjusted Hazard Ratio (AHR) with a 95% confidence interval (CI) was reported to identify significant predictors of neonatal mortality. Results Overall, the neonatal mortality rate in Ethiopia was 29.1 (95% CI: 26.1, 32.4) per 1000 live births. In the multivariable Gompertz gamma shared frailty model; male sex (AHR = 1.92, 95% CI: 1.52, 2.43), twin birth (AHR = 5.22, 95% CI: 3.62, 7.53), preceding birth interval less than 18 months (AHR = 2.07, 95% CI: 1.51, 2.85), small size at birth (AHR = 1.64, 95% CI: 1.24, 2.16), large size at birth (AHR = 1.53, 95% CI: 1.16, 2.01) and did not have Antenatal Care (ANC) visit (AHR = 2.10, 95% CI: 1.44, 3.06) were the significant predictors of neonatal mortality. Conclusion Our study found that neonatal mortality remains a public health problem in Ethiopia. Shorter birth interval, small and large size at birth, ANC visits, male sex, and twin births were significant predictors of neonatal mortality. These results suggest that public health programs that increase antenatal care service utilization should be designed to reduce neonatal mortality and special attention should be given for twin births, large and low birth weight babies. Besides, providing family planning services for mothers to increase birth intervals and improving accessibility and utilization of maternal health care services such as ANC is crucial to improve neonatal survival.

scholarly journals Breastfeeding as the Foundation of Care

1995 ◽  
Vol 16 (4) ◽  
pp. 1-14 ◽  
Author(s):  
Helen C. Armstrong
Keyword(s):  
Support Groups ◽  
Community Support ◽  
Small Scale ◽  
Parental Responsiveness ◽  
Effective Strategies ◽  
Adequate Care ◽  
Mother And Child ◽  
Child Spacing ◽  
Second Year ◽  
High Risk Infants

Breastfeeding, which unites food, health, and care, enhances the child's abilities to elicit good care through superior attachment, rhythmic synchrony, and vision and brain development. Parental responsiveness is increased by bonding, child spacing, and time with the baby Breastfeeding and other forms of care for nutrition share the aspects of interaction, cultural mediation, erosion of traditions, endemic misinformation, small-scale decision-making, and vulnerability to institutional mismanagement. Breastfeeding differs in requiring continuity of the caretaker and in facing social and profit-motivated opposition. Research is needed on adequate care for siblings, effective help for high-risk infants, improved duration, and nutrition of both mother and child in the second year of breastfeeding Despite effective strategies, such as the baby-friendly hospital initiative and community support groups, the challenge remains to move from motivating women to ensuring access to practical and confidence-building support.

scholarly journals Longitudinal Associations of US Acculturation With Cognitive Performance, Cognitive Impairment, and Dementia

2020 ◽  
Vol 189 (11) ◽  
pp. 1292-1305
Author(s):  
Erline E Martinez-Miller ◽  
Whitney R Robinson ◽  
Christy L Avery ◽  
Yang C Yang ◽  
Mary N Haan ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Cognitive Performance ◽  
Mixed Models ◽  
Culturally Diverse ◽  
Sociodemographic Factors ◽  
Mexican Descent ◽  
Sociocultural Context ◽  
Low Socioeconomic ◽  
Diverse Groups

Abstract US Latinos, a growing, aging population, are disproportionately burdened by cognitive decline and dementia. Identification of modifiable risk factors is needed for interventions aimed at reducing risk. Broad sociocultural context may illuminate complex etiology among culturally diverse Latinos. Among 1,418 older (≥60 years), low–socioeconomic position (SEP) Latinos (predominantly of Mexican descent) in Sacramento, California, we examined whether US acculturation was associated with cognitive performance, cognitive decline, and dementia/ cognitive impairment without dementia over a 10-year period and whether education modified the associations (Sacramento Area Latino Study on Aging, 1998–2008). Analyses used linear mixed models, competing-risk regression, and inverse probability of censoring weights for attrition. Participants with high US acculturation had better cognitive performance (0.21 fewer cognitive errors at grand-mean-centered age 70 years) than those with low acculturation after adjustment for sociodemographic factors, practice effects, and survey language. Results may have been driven by cultural language use rather than identity factors (e.g., ethnic identity, interactions). Rate of cognitive decline and risk of dementia/cognitive impairment without dementia did not differ by acculturation, regardless of education (β = 0.00 (standard error, 0.00) and hazard ratio = 0.81 (95% confidence interval: 0.49, 1.35), respectively). High US acculturation was associated with better cognitive performance among these older, low-SEP Latinos. Acculturation may benefit cognition when SEP is low. Future studies should incorporate extended longitudinal assessments among more diverse groups.

The influence of wife's education on fertility in rural Egypt

1976 ◽  
Vol 8 (1) ◽  
pp. 53-60 ◽  
Author(s):  
Atef M Khalifa
Keyword(s):  
Family Planning ◽  
Infant Mortality ◽  
Family Size ◽  
Pregnancy Loss ◽  
Inverse Relationship ◽  
Contraceptive Use ◽  
Inverse Association ◽  
Live Births ◽  
Positive Correlations ◽  
Desired Family Size

Based on survey data from rural Egypt, the effects of the wife's education on fertility and family planning were investigated and shown to be very important. In accordance with the results of most other studies, there is an inverse relationship with the number of live births. The wife's education is also shown to influence attitudes towards family size, spacing, and knowledge and approval of contraceptives, all of which lead to a high proportion of contraceptive use and help to achieve the desired family size. There was also a clear inverse association between the wife's education and pregnancy loss and infant mortality; these latter two variables showed positive correlations with the number of live births.(Summary in Arabic on p. 60)

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